Over 35? A smoker? No birth control pill for you

Not allowing doctors to weigh patients' individual circumstances because of a blanket insurance dictate undermines the quality of treatment they can provide.

A friend of mine recently went to the medical clinic she’s been going to for 12 years to get her annual physical and renew her prescription for birth-control pills. She was surprised when the nurse practitioner refused to write it.

Citing her age (42) and smoking habit as risk factors for blood clots, the nurse told her that prescribing the pills would create a liability problem for her and the clinic.

The clinic, Ingersoll Family Physicians, which is part of Iowa Health Physicians in Des Moines, blanketly denies the pill to women over 35 who smoke, the clinic administrator confirmed to me.

My friend has been taking the pill the whole time, including the seven years she’s been over 35. Different practitioners have treated her, all have explained the risks and emphatically encouraged her to quit smoking, but let that choice be hers.

It’s a risk she’s willing to take. She doesn’t want more kids. Besides providing birth control, the pill is the only thing she’s found to ease her severe, “life affecting” hormonal problems.

So she took her business to another doctor, who wrote her a prescription. Of the nurse, she says, “She was very obviously more concerned about her own liability and her own values than my own informed judgment and health-care needs.”

An Iowa Health spokesperson didn’t answer my questions about whether the policy is an insurance company dictate, but the chief operating officer of Planned Parenthood of Greater Iowa was clear on why it has the same policy, which she says is fairly standard nationwide.

“If your insurance company that provides liability insurance says, ‘Don’t do that,’ you don’t do that,” said Penny Dickey. “Ours is very clear on what we can and can’t do.”

Shouldn’t adults in consultation with doctors have the right to make their own medical choices? My friend wondered whether the nurse considered the risks of getting pregnant at 42, both to her and the fetus, such as the dramatically higher risk of Down syndrome and spina bifida.

The Ingersoll clinic administrator forwarded me guidelines from the American College of Obstetrics and Gynecology, listing what it considers acceptable and unacceptable risks.

My friend, as a light smoker with no family history of blood clots, should fall in the “acceptable” range. But the clinic takes a “one size fits all” approach.

“Of course, it is more risky to be pregnant and smoking than to be on a birth-control method,” acknowledged Dickey. “But being a provider that gave you that method could lead to a problem for the provider” – namely lawsuits. “Even though they (patients) say, ‘Yes, I understand the risk,’ doesn’t prevent them from suing us.”

Why not have them sign a liability waiver? My friend says the nurse finally agreed to give her a one-month supply of pills to tide her over if she signed a waiver. She did, and wonders why she couldn’t have that option with a regular prescription.

Granted, the already exorbitant cost of health care goes up when people engage in risky behavior such as smoking. That’s why health insurers add a surcharge for providing coverage to smokers.

But not allowing doctors to weigh patients’ individual circumstances because of a blanket insurance dictate undermines the quality of treatment they can provide.

On top of that, you have to worry whether it’s even safe to confide certain information to your doctor or whether it will end up in insurers’ hands.

Someone else I heard from said she admitted smoking pot to a physician’s assistant, who wrote it into her medical records, where it was seen by a life-insurance provider, which used the information to deny her increased life insurance.

Your doctor, of all people, needs to know the whole truth – and consider the whole picture – when treating you. It’s going too far when insurance companies can interfere with that.

Rekha Basu is an editorial columnist for the Des Moines Register. E-mail: rbasu@dmreg.com.

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